e20049 Background: Consolidation durvalumab after chemoradiation improves outcomes in patients with locally advanced NSCLC, but pneumonitis remains a clinically significant toxicity. The impact of taxane-based chemotherapy on pneumonitis risk and survival remains unclear. We evaluated this association in a real-world cohort of NSCLC patients treated with curative-intent chemoradiation and durvalumab. Methods: We conducted a single-center retrospective study of patients with NSCLC treated with concurrent chemoradiation followed by durvalumab, including unresectable and select oligometastatic cases treated with definitive intent between 2017-2025. Patients were grouped by receipt of taxane vs. non-taxane based chemotherapy. The primary endpoint was grade ≥2 pneumonitis. Multivariable analysis adjusted for treatment group, smoking status, nodal stage, delivered radiation dose, mean lung dose, and time from radiation completion to durvalumab initiation. Time to grade ≥2 pneumonitis was assessed using cumulative incidence methods, accounting for death as a competing risk. Overall survival (OS) was assessed with multivariable analysis adjusting for age, sex, smoking status, histology, delivered radiation dose, disease stage, and grade ≥2 pneumonitis. Results: A total of 289 patients were included (non-taxane n = 81; taxane n = 208). The median age was 65 years (range 39-87) in the non-taxane group and 70 years (42-86) in the taxane group. The majority of patients were male (58% in non-taxane vs 54% in taxane). Most patients were former smokers (62% vs 71%), with similar proportions of current smokers (23% in both groups). Histology differed between groups: squamous cell carcinoma was more common in the taxane group (45% vs 17%), whereas non-squamous histology was more frequent in the non-taxane group (64% vs 38%). Grade ≥2 pneumonitis occurred in 25% of non-taxane and 24% of taxane patients. On multivariable analysis, taxane use was not associated with pneumonitis risk (OR 1.00, 95% CI 0.54-1.90; p > 0.9). Being a former smoker (OR 2.20, 95% CI 1.07-4.91; p = 0.040) and increasing mean lung dose per 5 Gy (OR 1.74, 95% CI 1.23-2.55; p = 0.003) were independently associated with a higher risk of pneumonitis. Delivered radiation dose, nodal stage, and interval to durvalumab were not significant. Median OS for the cohort was 55 months (95% CI 34-76; p = 0.16), with no difference by treatment group. Taxane use was not significantly associated with OS on multivariable analysis (HR 1.31, 95% CI 0.83-2.08; p = 0.3). Conclusions: In this real-world cohort of patients treated with definitive chemoradiation and durvalumab, taxane-based chemotherapy was not associated with increased pneumonitis risk or worse survival. Mean lung dose and former smoking status were key predictors of pneumonitis, emphasizing the importance of radiation optimization and individualized risk assessment.
Babu et al. (Thu,) studied this question.